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Specific Location/Rural Address Request <br /> (Entire Form To Be Completely Filled Out Before Staff Can Respond to the Request) <br /> Today's Date 5/ <br /> Township/ Section of Needed Address P,-71- ,,,.j f <br /> 1V tie_ Cie r' lad <br /> Specific Area/Nearby Roads Cc��r,n.�,r c Q ta S�or`�2_ �d �., <br /> Parcel # QS p c <br /> Person/Entity making this request D-. ■" 1 l°S <br /> Contact Information for requestor <br /> Date of Original Request to this Agency(Date Stamp here) <br /> (To be filled in by Planning and Development Staff only) <br /> Short Narrative of what you know about this situa ion, and any collateral information that <br /> you have obtained in this matter. N..Z S F <br /> (Includ�y specific request o�ggestion that may be important to Staff who are working on the Assignment of the Rural Address) <br /> f on, <br /> ACO ()A.0 ) 9 4.3g140 _ 1-79 RD ` <br /> < C9j <br /> 3 R <br /> Q' tqoi.-, <br /> Staff person taking in this request <br /> Requestor shall for provide a site plan, drawn to a measurable scale, including lot lines & <br /> lot dimensions, and any existing or planned ingress/egress to the property, and the <br /> distance from the lot lines to the ingress. <br /> Filed by Town & Section <br /> Form 2006- A 10-10-06 <br />